When you ask someone what they think of when they hear the term “ADHD”, they often say that they picture a boy who is hyperactive. And that’s accurate – there are some boys with ADHD who are hyperactive.

But ADD/ADHD can go far beyond boys who are hyperactive.

There are also boys who are inattentive, girls who are daydreamers, young men who get angry easily, young women who are “too emotional”, and a whole range of other different ‘presentations’ of how people seem when they have ADD or ADHD.

In my office, after completing an assessment, I discuss with a family that their child meets criteria for ADHD (if they do) and I explain more about it. It’s quite a common occurrence for the parent to say something like: “I know about ADHD because my other child has it (or my nephew has it; or I’m a teacher and I’ve had kids in my class with it), and I just don’t see my child having the same thing as the other kid(s) that I know with ADHD.”

I then go on to explain how ADHD can ‘look different’ in different people, and I explain how it is manifesting in their child.

While I’ve always known that ADHD can seem different from one person to another, the extent of the individual nature of ADHD really hit home recently when I was reading to prepare for a presentation to teachers. In the bookADHD in the Schools by Dupaul and Stoner, this point was made very clear. Before sharing Dr. Dupaul and Dr. Stoner’s insights, let me just give a brief overview of how ADHD is diagnosed with the DSM criteria.

The DSM-IV-TR (The Diagnostic and Statistical Manual of the American Psychiatric Association) lists 9 symptoms of inattention, and 9 symptoms of hyperactivity/impulsivity. To meet the criteria for ADHD, one has to have at least 6 symptoms on one or both of these two lists (inattention or hyperactivity/impulsivity).

If one has at least 6 symptoms of inattention, and fewer than 6 symptoms of hyperactivity/impulsivity, then one is diagnosed with ADHD- Inattentive Subtype.

If one has at least 6 symptoms of hyperactivity/impulsivity, and fewer than 6 symptoms of inattention, then one is diagonsed with ADHD- Hyperactive Impulsive Subtype.

If one has at least 6 symptoms on BOTH lists, then one has ADHD- Combined Subtype.

So, to meet criteria for ADHD Combined Type, one has to have at least 12 out of 18 symptoms of ADHD. Of course, one could have 13 symptoms, or 14, etc.

“There are at least 7,056 possible combinations of 12 out of 18 symptoms that could result in a diagnosis of ADHD-Combined Type.”

7,056 different combinations of ADHD symptoms!

No wonder there isn’t one stereotype for kids/teens and adults with ADHD.

And this only relates to the combined type of ADHD. There would be more combinations if we added inattentive only, or hyperactive impulsive only.

And this is just based on the combination of symptoms alone. If we go a little deeper, and look at the individual, and take into account things like:

Ethnic and cultural background

Personal life experiences

Likes and dislikes

Strengths and skills people have

Weaknesses and challenges people struggle with

Personality traits

The society they’ve grown up in…

And a whole lot of other varilables

It’s no wonder that not everyone with ADD/ADHD seems to ‘look’ the same, and appear to have the same type of ADHD.

Are there similarities between individuals with ADHD? Of course there are. To meet criteria for the diagnosis, one has to have a relevant number of symptoms, and there are clinical patterns which can emerge.

However, don’t ever dismiss ADHD as a diagnosis just because that one person doesn’t appear the way you think ADHD should look . That person is just an individual with ADHD (with all of their unique individuality).

I hope that after reading this blog post, you’ll share this message with other people about ADHD. One of the first steps to destigmatize and to improve understanding about ADHD in society at large is for people to have the facts. And if we can help people to realize that not every person with ADHD is a hyperactive boy, and we open people’s minds to the fact that people with ADHD can be either gender, they can have a whole range of different symptoms, life experiences and levels of achievement in life, then we can do a lot of good out there.

And once someone has been diagnosed with ADHD, it is important that we focus on their differences and strengths to help them to achieve their best outcomes.

Comments

Good point Doc. Recently bought your book. Looking forward to finding some time to read it. You have great insight and are very encouraging. Thanks for doing what you do. Your passion and enthusiasm is contagious.

Dr. H
I’m one of the math challenged folks and I wonder what did the math look like to get that figure? What I really appreciate is that you fleshed it out to include all the bullet points that influence how we live with our variety of ADHD. We don’t look alike and have no secret handshake. However, I believe we are magnetic and attract like-minded people to us.

Thanks for the clarification. I have a 11 year old with autism(moderate) and with a non-official concurrent ADHD symptoms. There could be so many changes that the new DSM5 will bring with regards to autism and other diagnoses that it really makes it difficult for many chidlren like my son. My son;s attention span varies and it really can become very extremely limited in many instances. It is difficult when the child shares concurrent diagnoses and then have 2 or 3 different medications for “different” symptoms. My son is back to one now (Risperdone, for autism, no longer in Intunivi or the other medication, I can not recall the name now, it was a non stimulant and they wer both for his unfocus, and or attention span) However, in the long run it was too much and the initial improvement of overall symptoms did not last long. So, it is really hard when the child has more than ADHD. My experience with my son continues to be a long unending journey.

Thank you, this is really useful as I often have trouble explaining to parents ( and some teachers) that a diagnosis of ADHD does not mean that the child or young person will have behavioural problems. You have provided a very clear explaination. I hope you don’t mind if I print it out and show it to people

I am a 40 year old IT professional with ADHD. I have been a victim of the stigma that goes along with it since the day I entered school. I have been encouraged at the strides that have been made to legitimize this condition. However, I am very concerned about the frequency which I am seeing ADHD medication warnings on the television news lately. These “News” stories are focusing on the abuse of ADHD medication by those without ADHD for academic achievement. The piece I saw this morning was primarily focusing on parents who knew the “Buzz words” to get a diagnosis for their child. The news anchor compared it to steroid abuse. It was refereed to as academic doping. They also brought up adults who simply take it to “unfairly” gain an advantage in the workplace. All of these types of articles are increasing the stigma against those of us who have had to fight this sort of thing all of our lives.
Someone needs to fight for us.
Chadd and ADDA do allot of good work, but we seem to be against some very powerful forces who seem to think ADHD is an excuse for underachievement or bad behavior. It seems to me that it is up to all of us to fight back. We need to do something about this. Start a petition, like I did. I wish everyone could experience for a day what it is like to be highly intelligent and dedicated, while struggling with the symptoms and stigma associated with ADHD.

Collin, I agree with you. I particularly like your comment: “They also brought up adults who simply take it to “unfairly” gain an advantage in the workplace.”
You are so right. It’s real and people need to understand better. Good luck with your petition.
(can a Canadian sign it?)

I am not sure if Change.org would care one way or the other. I would think it should not matter as long as the majority of the respondents are from the US. However, Canadian, Norwegian, or Greek I would think that a show of global support is certainly valuable.

Dr H-
Thank you for the post. You have been instrumental in helping my husband (and I) understand ADHD. I am an educator and one of the ones you mentioned – I thought I knew ADHD. My son is ADHD Combined and I wasn’t familiar with the broad spectrum of ADHD until he was diagnosed! I recently graduated with my masters in special education and still learning a great deal about it! I always look forward to sharing your posts with other educators. THANK YOU! I agree that ADHD is individualized, it is the job of the parents and educators to find strategies to help the child learn.

My favorite quote from this post:
“And once someone has been diagnosed with ADHD, it is important that we focus on their differences and strengths to help them to achieve their best outcomes.”

My son was always having trouble in school, my maternal grandfathers family have dyslexia, I grew up having it and we thought Evan had it too. Through a ugly separation and hours in court, he was tested and diagnosed with ADD. I thank you for all your information, it is a difficult time when your child is first diagnosed. There isn’t very much useful information out there, The most frustrating thing is that the way it is explained,everybody has a form of ADHD or ADD.
The thing that makes me mad is my ex wanted my son on the drugs, I found he has done better since the judge ordered that my son goes to a private school that deals with learning disabled children. He has gotten more confidence, better grades and a different out look. It also helps that he is in one house hold during school, and I can watch his diet (cut out chemicals and food dyes). Evan’s teachers (from both schools) and I feel that he does not need the drugs (his kindergarten/grade one teacher is dead set against any medication, She watched her son turn to harder drugs and believes that the meds she put him on for 10 years is what drove him to crystal meth and crime).I do believe that some people do need the meds, but those who don’t shouldn’t take any meds. It seams that teachers would like quiet obeying children and if it takes putting 60% of the boys in the class on meds, that is ok. When I was in school, from ’80-’89 there was never any talk about Ritalin, now it feels like if your kid isn’t on a drug, he isn’t normal.
Two of my sons teachers from his old school also taught my brother and I, and they felt that Evan had a lot of the same conditions, and he graduated on the honor roll and is a successful business man who runs his own equipment,
Thank you for your straight forward approach for us to get an understanding of what ADHD is and what our kids are going through.

Hi Doc, We live in India and my son had been prescribed Inspiral or Axcepta 10 mg for his ADHD problem. I have stopped this medication since mid-April after School closed because he gets facial ticks while on the med. Am worried if he will be able to focus on his studies as he is now in Std. IX and the last 2 years of School are quite crucial for his future education. Can you please help me. Thank You.

Hi!
I have read your book and it has really helped me understand my son. Unfortunately, I think I read it too late. He had already stopped taking his concerta and started self medicating with marijuana (I hope nothing else but ?) and has gone through severe depression (suicide attempts included). Right now we are trying to get help for him but because he is an adult, it is very difficult. (If only adulthood was determined by brain development and not arbitrarily by time spent on the planet we would have a better chance at it.)
We ended up at the hospital in Oakville and he was refered to a psychiatrist for meds (with whom my son didn’t gel). He was also refered to a social worker who came to visit once and has not shown up since.
One of my son’s greatest difficulties is with working memory. I’m pretty certain that he was not able to even remember why he was there. All he knows right now is that he is angry and his parents must be to blame.
Help!

Kenny,
Often the diagnosed ADD condition is APD – Attention Priority Deficit. The person is not paying attention because there is something else that is more important, or the diagnosing teacher is so boring and making the subject very uninteresting.
It also is possible that the person has un-diagnosed dyslexia or another chromatic vision problem such as a hypersensitivity to the excess blue typical in fluorescent lights such as what are used in most classrooms. Most (competent) Special Education Teachers know that fluorescent lights tend to make children who are diagnosed with ADHD to be even more hyperactive.
We are hoping with our free color acuity test at http://www.dyop.org to be able to correlate color perception and dyslexia and possibly ADD behavior.

Hi Dr Kenny
Thank you very much for your continous moral support for ADHD parents.I have 11 years old son. He was dignosed with ADHD when he was 7 & he attended group therapy for 2 years(improved but not much).Then he took stratera for 2 years. Of course stratera did let him improve both behavioural and academic to the extent that he got honors this year in school and got highest mark in math. Now his doctor advised to stop med. to avoid side effects and i wonder what will be the outcome specially after his acheivements. i dont know what to do? please try to reasure me because i am very afraid of what the future will be.

I know this post is a bit old but I wanted to respond – I think that it is really great that you have highlighted the diversity of presentations of ADHD. The biggest problem we have, to quote Dr. Barkeley, is that we misnamed it – since its name is a symptom descriptor only of the most disruptive type of ADHD, many cannot take it seriously or understand the broader ramifications of what it means to live your life with executive functioning impairments. I believe the misnaming is the reason we failed to recognize its continuation in adults and why 90% of the adult population remains undiagnosed.

I had no idea that I could be ADHD, since I was a “good kid” who was intelligent and very interested in a lot of school – (not math, but that’s another story)…with the full-time tutoring of a “pushy” mother in a high-achieving district, I really had few problems throughout grade school -certainly nothing on the order of the “prototypical” bad kid with acting out and behavioral problems. College was also not terribly difficult, but, like many other “gifted” and ADHD students, I skirted by on my brains alone…without studying a day in my life. It was the adult work world that has elucidated my significant deficits…with an inability to manage time, prioritize, follow rules, fit in with others, and do anything resembling “work,” I spent most of my time criticising the organization and/or company for what it did wrong…well, you can imagine, I was fired from the 4 jobs I managed to get (and this after hundreds of interviews). Now at 35 am back “in school” since it’s pretty much the only thing I do well…on the road to being an absent-minded professor. I don’t want to take meds, but without them, I fear a life of persistent underachievement and an inability to succeed…that’s not “enhancement,” it’s keeping me from permanent disability.

Re the comment about the parent who felt that the medication may have led to drug addiction, I worked in the alcohol and drug area for years, and of the many thousands of clients seen at the various services, some did have ADD and had been on medication as a child, but they were the tiny minority. It is more likely that diagnosis and appropriate treatment (or even just a bit of understanding) is helpful and, if anything, likely to lessen the risk of going down the alcohol and drug pathway (but it is fairly common in society, sadly, ADD or not).

Also, some doctors in my country take a rather cynical view that Adult ADD is a pretext to get Ritalin, because it does a street value, with some parents selling their children’s medication.

I was an undiagnosed child with ADD (at the least). I daydreamed and was bored much of my school life. Now at 75 (July 27th), I find I still have difficulty sticking to the subject unless it is extremely organized.
Often times this is not possible.
Thanks for the attention you gave this subject.

My 11 year old was recently diagnosed with quiet ADD – something I suspected for years but was able to do workarounds for with social coaching and enrolling her in activities that catered to her extreme creativity whenever possible because school and dealing with people in general were a nightmare for me while growing up – I wanted to spare her the feelings of awkwardness, isolation, and bullying that I endured.

I wish my husband would believe the diagnosis. He gets hostile when we even bring it up, because “She’s a GOOD kid! She’s can’t be ADHD/ADD, she’s smart, she can sit still and isn’t tearing up everything in sight, and YOU’RE MEDICATING HER OVER MY DEAD BODY AND DON’T YOU DARE INFLICT ALL THE GARBAGE IN THE BOOKS YOU’RE READING ABOUT IT BECAUSE IT’S ALL A FAD!” I’ve pretty much had to handle this on my own and I feel so lonely. Ironically my daughter has no problem with the diagnosis, and seems relieved as in: “Now I know why I’ve always felt different from everybody around me!”